Equity of what in healthcare? Why the traditional answers don't help policy--and what to do in the future.

Introduction There are many deep philosophical issues regarding equity that I will slide over in order to address some practicalities of equity policy (see, for deeper material, Olsen 1997; Wikler and Murray forthcoming). However, I do want to try to link theory and policy rather than keep them in their usual silos. This is a dangerous plan. My amateur ethics will strike serious philosophers as gravely deficient, while my amateur policy strategizing will strike decision-makers as distantly up in the clouds. However, in the spirit of “nothing ventured ...” I am going to try to link the two more directly than is usual. One reason for doing this is that, if we cannot discuss ethics explicitly as a foundation of policies for equity in health and healthcare policy, then I doubt we can do it anywhere else. A second reason is that I think there is a chance, if we can be more explicit about our ethics, that we might manage to translate them into policy action in reasonable and doable ways. Another reason is that I am fairly confident that the reasonable and doable ways will be different from the current ways. A fourth is that leaving the ethics largely implicit means that the huge differences between us that might otherwise remain submerged could become underwater reefs with the potential to rip the bottoms out of well-meaning policies for equity in practice – as soon as it becomes clear that one person’s Equity of What in Healthcare? Why the Traditional Answers Don’t Help Policy – and What to Do in the Future

[1]  C. Hertzman,et al.  Healthier Societies: From Analysis to Action , 2005 .

[2]  I. Chalmers If evidence-informed policy works in practice, does it matter if it doesn't work in theory? , 2005 .

[3]  Grethe Peterson,et al.  The Tanner Lectures on Human Values , 1988 .

[4]  J. Eatwell,et al.  Welfare Economics , 2020, Encyclopedia of Public Administration and Public Policy, Third Edition.

[5]  A. Culyer,et al.  The morality of efficiency in health care--some uncomfortable implications. , 1992, Health economics.

[6]  N. Daniels,et al.  Accountability for reasonableness. , 2000, BMJ.

[7]  J. Lynch,et al.  Income inequality as a determinant of health , 2006 .

[8]  Anthony J Culyer,et al.  Equity - some theory and its policy implications , 2001, Journal of medical ethics.

[9]  A. Culyer,et al.  Deliberative processes and evidence-informed decision-making in health care: do they work and how might we know? , 2006 .

[10]  Anthony J Culyer,et al.  The bogus conflict between efficiency and vertical equity. , 2006, Health economics.

[11]  Norman Daniels,et al.  Accountability for reasonableness , 2000, BMJ : British Medical Journal.

[12]  J. Rawls Justice as Fairness , 2001 .

[13]  V. Wiseman,et al.  Burden of disease and priority setting. , 2000, Health economics.

[14]  J. Olsen Theories of justice and their implications for priority setting in health care. , 1997, Journal of health economics.

[15]  Angela Coulter,et al.  The Global Challenge of Health Care Rationing , 2000 .

[16]  A. Sen,et al.  Social Choice Theory: A Re-Examination , 1977 .

[17]  Angela Bate,et al.  Programme budgeting and marginal analysis: bridging the divide between doctors and managers , 2005, BMJ : British Medical Journal.

[18]  C. Propper,et al.  The redistributive effect of health care finance in twelve OECD countries. , 1999, Journal of health economics.

[19]  A. Sen,et al.  Equality of What? , 1980, Seven Deadly Economic Sins.

[20]  Iain Chalmers,et al.  Trying to do more Good than Harm in Policy and Practice: The Role of Rigorous, Transparent, Up-to-Date Evaluations , 2003 .